pancreatic conditions Flashcards
(24 cards)
key causes of acute pancreatitis
alcohol - toxic to pancreatic cells
gallstones - blocks bile flow
post-ERCP
acute pancreatitis pathophys
autodigestion of pancreatic tissue by pancreatic enzymes, leading to necrosis
acute pancreatitis presentation
severe epigastric pain - may radiate to back
- vomiting
- low grade fever
- epigastric tenderness
cullens sign = periumbilical discolouration
acute pancreatits investigations
serum amylase (level not of severity/prognostic value)
serum lipase - more sensitive/specific
imaging
- diagnosis can be made without
- US to find cause
which investigation would be useful in a late presentation (>24hrs) of acute pancreatitis
serum lipase
- has a longer half life than amylase
factors indicating severe pancreatitis
age >55
hypOcalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH + AST
other causes of pancreatitis
ethanol
mumps
scorpion
hypothermia
drugs - azathioprine, mesalazine, bendroflumethiazide, furosemide
acute pancreatitis complications
peripancreatic fluid collections
pseudocyst - from organisation of peripancreatic fluid collection
- mx = observe for 12wks, 50% resolve, if not aspirate/cystogastrotomy
pancreatic necrosis
abscess (infected pseudocyst)
haemorrhage
systemic complications of acute pancreatitis
acute respiratory syndrome
(high mortality - 20%)
acute pancreatitis management
fluid resus - agressive with crystalloids
analgesia
nutrition - enteral in mod or severe
what typical types of care should be AVOIDED in acute pancreatitis management
should NOT be
- made nil by mouth - enteral nutrition
- offered prophylactic antimicrobial/Abx - only if necrosis
role of surgery in mx of pancreatitis
gallstones - cholecystectomy / ERCO
necrosis with organ dysfunction - debridement/aspirate
pancreatic cancer
diagnosed late, non specific px
80% adenocarcinomas typically at head of pancreas
pancreatic cancer association
increasing age
smoking
diabetes
chronic pancreatitis
hereditary non-polyposis colecrectal carcinoma
MEN
BRCA2 gene
KRAS gene
pancreatic cancer presentation
painless jaundice
- pale stools, dark urine, pruritus
abdo masses
- hepatomegaly - mets
- gallbladder - Courvoisers law
- epigastric mass - primary tumour
non-specific sx - back pain, weightloss
steatorrhea - loss of exocrine func.
diabetes - loss of endocrine func.
Courvoiser’s law
in presence of painless obstructive jaundice, a palpable gall bladder is unlikely to be due to gallstones
-> instead consider malignancy
pancreatic cancer investigations
high resolution CT
- “double duct” sign -> simulataneous dilatation of common bile + pancreatic ducts
pancreatic cancer mx
Whipples (pancreaticoduodenectomy)
adjuvant chemo
ERCP with stenting used for palliation
<20% suitable for surgery
chronic pancreatitis causes
80% = alcohol excess
- genetic - CF, haemochromatosis
- ductal obstruction
chronic pancreatitis
epigastric pain
- radiates to back
- worse following meal
- relieved by sitting forward
steatorrhoea
diabetes
(these are fails of exocrine +endocrine systems, sx dont px till 20years after pain)
chronic pancreatitis investigations
CT
- most sensitive at detecting pancreatic calcification
faecal elastase - to assess exocrine function
chronic pancreatitis management
pancreatic enzyme supplements
analgesia
which electrolyte abnormality is indicative of more serious pancreatitis
hypOcalcaemia
(part of Glasgow pancreatitis score)
other causes of raiseed serum amylase
small bowel obstruction - pressure on pancreatic duct
pancreatic pseudocyst
mesenteric infarct
perforated viscus
acute cholecystitis
diabetic ketoacidosis
